Assessment of autonomic dysfunction in Guillain‐Barré syndrome and its prognostic implications

Abstract

ABSTRACT— Twenty‐four patients with Guillain‐Barré syndrome were prospectively evaluated for evidence of autonomic dysfunction. It occurred in 16 (66.7%) patients, usually during the peak period of paralysis, in the form of either excess or inadequate activity of sympathetic and/or parasympathetic nervous systems. Its clinical manifestations comprised of sinus tachycardia (33.3%), bradycardia (8.3%), hypertension (33.3%), postural hypotension (35%), urinary sphincteric disturbances (20.8%) and anhydrosis of lower limbs (12.5%). Assessment of cardiovascular responses to autonomic function tests revealed impaired alterations in heart rate during deep breathing (31.6%), Valsalva's manoeuvre (28.6%), sustained handgrip (25%), cold‐pressor test (36.4%), postural change (35%) and atropine test (20%); and impaired rise in blood pressure during firm handgrip (25%) and cold‐pressor test (36.6%). ECG abnormalities were noticed in 8 (33.3%) patients. They comprised of depressed ST segment in 5, inverted T wave in 3, tall T wave in 2 and prolonged QTc in 2 patients. Two patients died of respiratory failure. Autonomic dysfunction in Guillain‐Barré syndrome did not appear to have any prognostic significance as there was no significant difference in autonomic dysfunction between good—and bad—outcome groups of patients. Copyright © 1987, Wiley Blackwell. All rights reserved